- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,897.79 / $11,220.18
| Facility | | $1,122.02 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,258.93
| Professional | | $501.19 | $758.58 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $19,952.62 / $27,542.29
| Facility | | $8,317.64 | $19,952.62 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,348.96 / $2,041.74
| Professional | | $812.83 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $13,182.57 / $43,651.58
| Facility | | $831.76 | $13,182.57 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,479.11 / $1,479.11
| Facility | | $758.58 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $4,073.80
| Professional | | $1,122.02 | $1,380.38 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,762.47 / $10,964.78
| Facility | | $3,235.94 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $741.31 / $1,174.90
| Professional | | $251.19 | $741.31 | $1,174.90 |